STEPHANIE INGRID BALLEZA GUMBAN Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070022007

License Status

NOT RENEWED

Business

First Name

STEPHANIE

Middle

INGRID BALLEZA

Last Name

GUMBAN

Business Name

STEPHANIE INGRID BALLEZA GUMBAN

Original Issue Date

02/04/2016

Effective Date

09/26/2018

Expiration Date

09/30/2020

City

HACKENSACK

State

Zip

07601

County

COOK

Ever Disciplined

LastModifiedDate

01/14/2021